Smoking has blinded more than 1300 New Zealanders, says medical research published today.

One of the researchers, Dr Nick Wilson, said yesterday that 400 people each year needed cataract surgery also because of smoking.

The findings, published in the New Zealand Medical Journal, call for tobacco packets to carry warnings on smoking and blindness.

The Health Ministry said it would consider this, but the Government had given it other priorities in tobacco control.

Dr Wilson, a Wellington independent public health physician, said the 1300 who had been blinded - most of them fully - by smoking suffered from a
condition called age-related Macular degeneration (AMD), which had cost more than 5200 New Zealanders their eyesight.

The macula is the part of the eye that distinguishes fine detail at the centre of the field of vision.

Most AMD cases cannot be treated, but laser treatment will sometimes limit the loss of vision.

Dr Wilson said AMD was the main cause of blindness in those aged over 55. Ageing itself was one of the causes of the condition.

"Smoking accelerates the whole ageing process. The damaging chemicals in tobacco smoke possibly have an effect."

Smokers' bodies also had lower levels of anti-oxidants, which helped maintain good health.

The article also says toxic heavy metals in cigarettes are thought to cause cataracts - loss of lens clarity.

The researchers estimate that 400 cases of cataract surgery each year, or 13 per cent, are due to smoking.

In what is the first assessment of the effects of smoking on New Zealanders' eyesight, the researchers applied overseas findings and say their
figures are probably an underestimate.

Health Ministry spokesman Matthew Allen said there had been calls for many conditions, including strokes, to be included in health warnings on
tobacco packets.

Warnings introduced last year must be allowed to bed down before any new ones could be considered.

He said the ministry's priorities were the smokefree legislation now before Parliament and looking at the disclosure and controlling of
constituents in tobacco.

Retina specialist Dr Dianne Sharp said the main factor associated with AMD was ageing, but in the last five years two large studies had shown that
smoking increased the risk.

About 1000 New Zealanders a year developed AMD, she said.

A significant number lost their central vision solely because they smoked.

Dr Sharp doubted that those people would realise smoking was the cause.

"I don't think the public know about the link at all."

The condition meant people could not read, drive a car or watch television, and had difficulty getting around.

"It is not like total blackness ... but it is a severe visual impairment."

Ophthalmologist Dr Trevor Gray said AMD was the leading cause of blindness in Westernised countries.

He also believed there was little public awareness of the link with smoking.

About 40 other factors, including sunlight and diet, could contribute to AMD, he said.

Foundation for the Blind spokesman Chris Orr said 67 per cent of its clients were aged over 65.

About 20 years ago, a senior staff member decided to cancel an annual $25,000 donation of petrol vouchers from a large tobacco company.

Mr Orr said the staff member had suspected that smoking and blindness might be linked, and such sponsorship was inappropriate.

John Galligan, of industry group British American Tobacco NZ, said it was up to the Government to decide which health warnings were printed on
cigarette packets.

His organisation would wait to see the research peer-reviewed.

"Because a report says one thing doesn't necessarily make it true. It just takes it up there for debate among the scientific
community."

Since I work in this field, I find this thread interesting. What I find most interesting is the statement in the first article that says,
"two studies have shown that smokers who take the antioxidant beta carotene have an increased
risk of developing lung cancer. In other words, good nutrition won't help you if you smoke."

Macular Degeneration is the leading cause of blindness in persons 55 and older. Here are some abstracts, with the link first:

Smokers at High Risk for Vision Loss and Other Problems

(San Francisco)- Studies from around the world continue to show cigarette
smoking is responsible for a wide range of health problems, including eye diseases such as macular degeneration and cataracts.

Results from a recent French study showed people who smoked at least 40 packs of cigarettes a year were found to have five times the risk
of macular degeneration, compared with nonsmokers. This increased risk lasts for up to 20 years after the cessation of smoking. An Australian study
similarly found smokers have a four-fold increased risk of macular degeneration.

Numerous studies in recent years have suggested the benefit of taking antioxidant vitamins, carotenoids, and minerals in decreasing the
risk of cataracts and macular degeneration. However, two studies have shown that smokers who take the antioxidant beta carotene have an increased risk of
developing lung cancer. In other words, good nutrition won't help you if you smoke.

Several studies have concluded that smoking one or more packs of cigarettes a day doubles a person's chance of developing macular
degeneration. Risk increases with both the intensity and duration of smoke exposure. Smoking may speed the process of degeneration by damaging chemical
compounds needed for pigment production, or by reducing the flow of blood, protective nutrients, and oxygen to the eye.

SAN FRANCISCO, CA -- April 2, 2001 -- A study pooling results from several population-based eye disease
studies conducted on three continents shows that tobacco smoking is the principal known preventable risk factor associated with age-related macular
degeneration (AMD). The study appears in the April 2001 issue of Ophthalmology, the clinical journal of the American Academy of Ophthalmology, the
Eye M.D. Association.

Rosemary, you just reminded me of something in my life a few years back that illustrates the full absurdity of the junky mind.

I was taking this really great multi-vitamin that was high in anti-oxidants. I really felt like I could feel benefits from it health-wise. Then my doctor
mentioned the increased risk of lung cancer associated with smoking and high levels of beta-carotene.

Guess which one I quit. Yup, I stopped taking the vitamin to decrease my risk. It honestly sounded logical at the time.

Smokers are always looking for ways to reduce the health risks of smoking. Unfortunately, most techniques
used to reduce the risk don't work, and, in many cases, may actually increase the dangers of smoking.

Probably the most popular method of risk reduction is switching to low tar and nicotine cigarettes.
If people only smoked to perpetuate a simple habit, low tar and nicotine cigarettes would probably reduce the dangers of smoking. Unfortunately, the
necessity to smoke is not continuance of a habit but rather maintenance of an addiction. Switching to a low tar and nicotine cigarette makes it difficult
for a smoker to reach and maintain his normal required level of nicotine. The smoker will probably develop some sort of compensatory smoking pattern.
Compensatory behaviors include smoking more cigarettes, smoking them further down, inhaling deeper, or holding the smoke down
longer.

By doing one or a combination of these behaviors, the smoker will reach similar levels of tar and
nicotine in his system as when he smoked his old brand, but, in the process, he may increase the amount of other potent poisons beyond what was delivered
by his old cigarettes. Low tar and nicotine cigarettes often have higher concentrations of other dangerous poisons. By increasing consumption,
substantially greater amounts of these poisons are taken into the system, thereby increasing his risk of diseases associated with these chemicals. One such
poison, found in higher quantities in many low tar and nicotine cigarettes, is carbon monoxide. Carbon monoxide is one of the major factors contributing to
the high incidence of heart and circulatory diseases in smokers. Also, to give flavor to the low tar and nicotine cigarettes, many additional additives and
flavor enhancers are used. Tobacco companies are not required to disclose what the chemical additives are, but the medical community suspects that many of
these additives are carcinogenic (cancer producing) and may actually be increasing the smoker's risk of tobacco-related
cancers.

The filter at the end of cigarettes also may make a difference in how much poison a smoker takes in.
Some filters are more effective than others, but, again, a smoker will generally alter the way he smokes rendering many of the protective actions of the
filters useless. Some cigarettes have holes inserted around the perimeter of the filter permitting more air to be inhaled with the tars and gasses of the
cigarette. Theoretically, this lowers the amount of the actual tobacco smoke being inhaled. But, a smoker will normally find these cigarettes difficult to
inhale and cannot get the amount of nicotine necessary to satisfy the craving. In response, he may smoke more or may discover an even more innovative way
to interfere with the filter's protective action. Many times a smoker will learn how to put the cigarettes a little deeper into his mouth and seal his
lips around the ventilation holes, thus decreasing the filter's efficiency. I have even encountered smokers in clinics who put tape around these holes
because they found the cigarette easier to inhale and generally tasted better. In the process, they inactivated the semiprotective mechanism of the filter.
Their attempts at making their smoking safer were simply an inconvenience and a waste of time. Filters could be developed that would take out all of the
nicotine, but, unfortunately, in order to satisfy the addiction, most smokers would give themselves a hernia trying to inhale.

One last method of risk reduction worth mentioning is vitamin supplements. The body's ability to
utilize Vitamin C is impaired by smoking. When some smokers learn this, they start taking supplemental Vitamin C. But vitamin C acidifies the urine,
resulting in the body accelerating the excretion rate of nicotine. In response, the smoker may smoke extra cigarettes. In the process, he will probably
destroy the extra vitamin C and increase his exposure to all of the poisonous chemicals found in tobacco smoke.

Almost every method of making smoking safer is a farce. There is only one way to totally reduce the
deadly effects of smoking, and that is, simply, not to smoke. Only then will your chances of diseases such as heart disease, cancer and emphysema be
reduced to the level of nonsmokers. And to keep your risk at these low levels, only one method is necessary-NEVER TAKE ANOTHER
PUFF!

Dumb question... can second hand smoke over prolonged periods of time (i.e. growing up with smoking parents who smoked inside the house and car) damage your
eyes? I was curious... because second hand smoke still has tons of junk in it that would come in direct contact with your eyes...

The researchers, from the University of Manchester, say the risk of going blind should be added to the list.

Age-related macular degeneration (AMD) is the leading cause of adult blindness in the UK, affecting about 500,000 people.

It results in severe and irreversible loss of central vision, especially in people over the age of 60. Awareness needs to be raised and an eye health warning
included on all cigarette packets. Ophthalmic surgeon Simon Kelly and his team claim around 54,000 people in the UK have AMD as a direct result of smoking.

Of these, they said 17,800 are completely blind.

The researchers are calling for a sustained public health campaign to raise awareness of the link between smoking and blindness, as well as
more commonly known risks such as cancer.

Mr Kelly said: "Evidence indicates that more than a quarter of all cases of AMD with blindness or visual impairment are attributable to
current or past exposure to smoking.

"Patients, health professionals, and the public will benefit from greater awareness of this causal association."

Greater publicity

Researchers said evidence suggests that giving up smoking helps reduce the risk of AMD in later life.

Quitting can also affect the long-term response to treatments such as laser therapy.

The Royal National Institute for the Blind (RNIB) agrees that greater publicity is needed to highlight the link between smoking and eye
damage.

"People fear losing their sight more than any other sense, said Anita Lightstone, RNIB Head of Eye Health.

"Therefore the fact that smoking does significantly increase a person's chances of losing sight from AMD should be more widely
publicised. We are getting to the stage where people are so cynical that not only won't they listen but they will start to laugh at scientists and the
medical establishment "Awareness needs to be raised and an eye health warning included on all cigarette packets, to help lower the number of people losing
their sight from AMD."

The pro-smoking organisation Forest has reacted angrily to the research branding it as "scaremongering".

"I think people have to ask how many people do they know who have gone blind through smoking.

"We have health scares on a daily basis and I think it is counter productive.

"We are getting to the stage where people are so cynical that not only won't they listen but they will start to laugh at scientists
and the medical establishment, which could have serious consequences in the future."

Treatment delay

Smoking causes lung cancer, but is also associated with more than 50 different diseases and disorders - many fatal.

Around 13 million Britons smoke and half of all smokers will die prematurely.

There are 120,000 smoking-related deaths each year and smoking-related diseases cost the NHS £1.5bn annually.

The government is currently under pressure for delaying the implementation of guidelines from the National Institute of Clinical Excellence,
which say that a treatment known as photodynamic therapy should be made available to treat AMD.

Ministers say the NHS needs more time to train up specialists, but the RNIB argues that the NHS already has the capacity to offer the
treatment, and says the delay will result in some people going blind unnecessarily.

Methods: Of 3654 Australians 49 years and older examined at baseline (January 14, 1992, through December 18, 1993), 2454 were examined 5
years later (January 11, 1997, through February 23, 2000), 10 years later (July 10, 2002, through November 4, 2005), or both. Retinal photographs were taken
to assess AMD. Smoking status was recorded at each interview.

Results: After controlling for age, sex, and other factors, current smokers had a 4-fold higher risk of late
AMD than never smokers (relative risk, 3.9; 95% confidence interval, 1.7-8.8). Past
smokers had a 3-fold higher risk ofgeographic atrophy (relative risk, 3.4; 95% confidence interval,
1.2-9.7). Joint exposure to current smoking and (1) the lowest level of high-density lipoprotein (HDL) cholesterol, (2) the highest total to HDL cholesterol
ratio, or (3) low fish consumption was associated with a higher risk of late AMD than the effect of any risk factor alone. However, interactions between
smoking and HDL cholesterol level, ratio of total to HDL cholesterol, and fish consumption were not statistically significant.

Conclusion: Smoking strongly increased the long-term risk of incident late, but not early, AMD, with a possibly greater effect in persons
with a low HDL cholesterol level, a high ratio of total to HDL cholesterol, and low fish consumption.

As seen with the above "past smokers" finding, there are risk prices for having long been where we once lived. But this
shouldn't come as a surprise. We never once took a puff off of any cigarette that didn't collectively destroy more of the 800 million air sacs with
which we started, that didn't further damage our blood flow piping or that didn't destory additional brain cells. To reflect upon this reality, one
need only focus upon the power of one chemical, the super toxin nicotine, and the ability of 1 mg of nicotine to kill the largest rat you've ever seen (1
to 1.5 pounds). As most of you already know, 1 mg. is the amount of nicotine delivered into the human bloodstream with each cigarette.

"Geographic atrophy is characterized by round or oval patches of atrophy of the retina,
retinal pigment epithelium and underlying choroid. Over time, the patches may increase in size and number or may coalesce to form larger areas of atrophy.
Geographic atrophy tends to be bilateral but may be asymmetric. Patients may complain of blurred or distorted vision, difficulty reading or driving, or
increased reliance on brighter light or magnifying lenses to perform tasks requiring fine visual acuity." http://www.aafp.org/afp/990700ap/99.html

I find this
thread very interesting because I have Graves disease and thyroid related eye disease. Mine is a pretty severe case in that it causes the tissue behind my eyes
to swell and I have had double vision for over a year. I knew that there were studies to prove that smoking makes this eye disease much harder to treat and
causes people to have more severe cases if they are smokers. I have known this info for over a year, yet continued to smoke until my eye surgeon sat me down
and explained that if I don't stop smoking, I will more than likely go blind. Up until then, no doctor had said a word to me about it.
I finally found the courage to NTAP and I can not believe how much the swelling in my eyes has gone down in just the 13 days since I have quit. It's
remarkable!! I can only hope my vision will improve and that it wasn't too late. I did not know other eye diseases were affected by smoking also, so thank
you for posting this and making people aware. I agree...more education!

PURPOSE: To investigate the association between smoking and subcapsular cataract and blood levels of cadmium and lead, and serum levels of vitamins C, E,
and beta carotene in the middle-age male population. SUBJECTS AND

METHODS: The present study comprised 60 cataractous male patients aged 44-55 years who attended Mansoura University Ophthalmic Center. They were divided into
two groups: the first group was comprised of 15 patients who had never smoked before with minimal exposure to cigarette smoking (control group), while the
second group was comprised of 45 age and body mass index-matched smokers. Blood cadmium and lead concentrations were measured and their levels in the
cataractous lenses were also estimated. The levels of some antioxidants, such as serum vitamins C, E, and beta carotene, were determined.

RESULTS: Cadmium had a statistically significant higher concentration in blood and lenses of smokers compared
with that of non smokers (p < 0.0001). There was a significantly high accumulation of cadmium in the lenses of cataractous
smokers reaching about a four-fold increase in heavy smokers (15.4 0.4 micromol/g) and nearly a three-fold increase in light smokers (10.1 0.4
micromol/g) when compared to that of nonsmokers (3.7 0.9 micromol/g). Regarding vitamins E, C, and beta carotene, a highly significant
reduction was observed in smokers when compared with nonsmokers. There was a highly positive correlation between blood cadmium concentrations and lens cadmium
levels, and blood lead concentrations and lens lead levels in heavy smokers.

CONCLUSION: Cadmium present in high concentrations among smokers was associated with the presence of cataracts,
through induction of oxidative stress as evidenced by reduction of levels of some antioxidant studied in this work, such as vitamins E, C, and beta carotene.
Thus, education of health care professionals and the public about the cataractogenic effect of cadmium is mandatory. Intake of various antioxidants may be
helpful in reducing the risk of cataract formation.

As we know, cataracts are a major cause of avoidable blindness. Cadmium is a heavy metal and potent environmental toxin present in tobacco smoke and used to
make batteries. In comparison to nicotine's biological half-life in humans of roughly 2 hours, cadmium's biological half-life is 30 years. What
follows are quotes from the full text of the above study summary:

Why did they undertake this study:

"It was assumed that changes in the cadmium and vitamin C levels in the blood might be responsible for cataractogenesis in the smokers. Although several
authors have reported a progressive accumulation of cadmium in senile cataract as brunescence advances; there are few reports on the cadmium contents in the
lens of smokers."

Discussion of the below findings:

In the present study, there was a higher concentration of cadmium in the blood of smokers than in nonsmokers. This increase was higher in heavy smokers due
to chronic smoking and also in higher age groups as cadmium accumulates with advancing age.

In the present study, there was a significantly high accumulation of cadmium in lenses of cataractous smokers reaching a fourfold increase in heavy smokers
(15.4 ・} 0.4μ mol/g) and a nearly threefold increase in light smokers (10.1 ・} 0.4μ mol/g) when compared to that of nonsmokers (3.7 ・} 0.9μ mol/g).

Cadmium may hasten cataractogenesis by various mechanisms. It may directly interact with lens proteins and denature them. Normally, it bounds to low
molecular weight proteins, the metallothioneins in the kidneys, liver, and the eye lens and also red cell hemoglobin. There is also free cadmium in blood
plasma. It is likely that as the concentration of cadmium increases in the blood, the hemoglobin bounds cadmium, and consequently loses its full power of
delivery of oxygen to tissues including ocular structures.

Also, cadmium is known to displace zinc and cupper in the body affecting their homeostasis of blood and cupper containing protein, such as ceruloplasmin and
enzymes including superoxide dismutase and cytochrome C. These enzymes are antioxidants, resulting in oxidant damage to the lens of eye resulting in the
lowering of circulating nutrients.

There is a growing consensus that smoking increases the risk of nuclear cataract and no association has been reported for cortical cataract. Smoking over a
pack of cigarettes a day increases cataract risk by 205% compared to nonsmoking in men.